- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $3,235.94 / $8,912.51
| Facility | | $467.74 | $3,235.94 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $389.05 / $741.31
| Professional | | $251.19 | $389.05 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $4,365.16 / $10,000.00
| Facility | | $1,995.26 | $4,365.16 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $380.19 / $707.95
| Professional | | $208.93 | $380.19 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $912.01 / $3,090.30
| Facility | | $416.87 | $912.01 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $478.63 / $1,023.29
| Professional | | $281.84 | $478.63 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $4,073.80 / $9,549.93
| Facility | | $1,318.26 | $4,073.80 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $389.05 / $758.58
| Professional | | $245.47 | $389.05 | $758.58 |